Dr. Bill Elliott: The handshake &mdash; a thing of the past?

Last week, I was about to see a patient with a bad chest cold. Through the exam room door I could hear him coughing uncontrollably.

As I walked into the exam room, I said hello and offered my customary greeting, a firm hand shake.

Pretty silly thing to do when someone is sick, but shaking hands is a traditional greeting — especially between men. The handshake is such a deeply established custom, it would have been rude to put my hands in my pockets. Or would it?

Perhaps the handshake, at least for healthcare providers, is a bad idea. Hand to hand contact is the best way to spread germs, including some very nasty bugs like flu and C. difficile.

It turns out that there are efforts underway to ban the handshake in the medical setting. Hand hygiene is integral to disease prevention programs in hospitals and clinics, and many think the handshake has no place in any healthcare setting.

But this is easier said than done. The handshake is an international symbol of greeting, friendship, agreement and respect. In the medical setting the handshake between healthcare practitioners and their patient shows empathy, connection and has the potential to comfort and calm.

But healthcare workers are also vectors of disease. Infected or contaminated doctors and nurses have the potential to spread deadly diseases. That is why hand hygiene, especially hand washing, has been recognized as one of the most fundamental steps in preventing spread of disease in hospitals. You would think that doctors and nurses would wash their hands regularly throughout their day, especially when going from patient to patient, but studies have shown that this only happens about 40 percent of the time.

So should we ban handshaking in the health care setting?

It isn't as easy as it sounds. It would require an extensive education program. Otherwise some healthcare workers could appear to be cold or uncaring.

Some experts, including the authors of an editorial in the May 15 Journal of the American Medical Association, ask us to consider "practical and infection-conscious alternatives" to the handshake Perhaps hospitals and clinics should establish "Handshake-free zones". Signs in hospitals and clinics could implore us "to protect your health and the health of those around you, please refrain from shaking hands."

There could be other gestures, such as a wave or salute could possibly replace the handshake. The authors of the editorial even suggest traditional gestures such as putting the right hand over the heart or putting both hands together with a slight bow — none likely to catch on quickly especially with older, more traditional doctors and nurses.

But this discussion is a start. Is the handshake a thing of the past? Probably not, but since it is likely that handshaking has the potential to spread disease so we certainly need to look at it.

Just don't be upset if I give you a bow the next time I see you.

Dr. Bill Elliott is an internist at Kaiser Novato and an assistant clinical professor of medicine at UCSF. His column appears every third Monday.